Medically Assisted Dying in the Global South

Abstract

As is often the case in discussions of global issues, developments in the global south are somewhat neglected. I noted in a recent Editorial in a previous issue of Developing World Bioethics significant achievements in terms of access to abortion care in a number of countries of the global south.1 This progress is largely ignored in media reports, given most large media organisations focus on the United States and other countries of the global north. The same holds true for developments in the context of medically assisted dying.

In recent years the number of jurisdictions that have decriminalized or legalized medically assisted dying involving assisted suicide or euthanasia has steadily increased in the global north. A somewhat heated debate continues not so much on the ethical permissibility of assisted dying, but on questions of scope, namely who should be eligible for an assisted death. Most controversial is the inclusion of non-terminally ill, decisionally-capable people with disabilities and/or mental illnesses. I have written elsewhere extensively on these issues.2 Today I want to draw your attention to an entirely different issue. Medical assistance in dying in the global south.

During the last few years, Developing World Bioethics has seen a remarkable uptick of submissions from countries of the global south that address ethical issues of medically assisted dying in particular countries of the global south. Examples of this include articles on euthanasia in Colombia,3 Chile,4 India,5 Ecuador,6 and China7 (in no particular order). Ecuador and Colombia have legalised active euthanasia, and, in an interesting court case, a court in Peru permitted euthanasia for a particular patient. Chile permits passive euthanasia, as does India.

At the time of writing court cases are progressing in various countries of the global south, with the aim to see the practice decriminalized or legalized, including, among others, in South Africa. Anton van Niekerk, a long-serving member of our Editorial Board, has been at the forefront of these debates in his native country.8 Willem Landman, a founding Editor of this journal is also actively involved in the South African court case. A peculiar South African contribution to the debates on assisted dying is the question of whether or not such a practice would be contrary to African culture. I am no expert on African culture, but I wonder whether there is a uniform African culture with an uncontroversial universally agreed-on view on assisted dying. Reportedly Teslio Thipanyane, the Head of the South African Human Rights Commission, declared publicly that the country's ‘constitutional rights of dignity and “of every individual to control of his or her own body” are a clear basis for euthanasia or assisted suicide.’ 9 Perhaps there is no such a thing then as an ‘African culture’ voice that would settle at least the question of whether or not euthanasia would be an un-African activity. Unsurprisingly, and reassuringly, like in the global north, African people appear to hold diverse views on the practice.

It seems as if there is an uptick in activities in the global south pushing toward decriminalizing or legalizing this practice, as there is in the global north. I am interested in learning more about the ethics and policy debates on this topic in the global south. For instance, does the fact that health care systems are typically weaker in the global south make a difference to an ethical evaluation of this practice? Are weaknesses in the states’ abilities to enforce their laws and regulations an issue that might make a difference in the ethical evaluation of euthanasia? Are there distinct cultural differences that would give rise to ethical arguments hitherto not discussed in the literature?

As an Editor of this journal, I would encourage our readers to reflect on this subject matter and submit considered ethical analyses for review to us, with a view to seeing this content eventually published in these pages. I am certain that it would enrich the ethics and policy discourse currently taking place globally.